Conservative treatment of abdominal organ trauma in children – a 8 year single center retrospective observation

<b>Introduction:</b> Trauma remains the leading cause of death in the pediatric population under 18 years of age. Non-operative management (NOM) has become the standard of care for hemodynamically stable pediatric patients with nonpenetrating abdominal injuries. <br><br><b>Aim:</b> This study evaluates the application of the American Pediatric Surgery Association (APSA) guidelines in a pediatric trauma center in Krakow, Poland, between 2017 and 2024. <br><br><b>Methods:</b> A retrospective analysis was conducted on 295 pediatric patients hospitalized with multi-organ injuries, including the intra-abdominal ones. The data were analyzed with respect to injury severity, hospitalization duration, and outcomes. Statistical methods included Shapiro-Wilk tests, Mann-Whitney U tests, Spearman's rho correlation, and chi-square tests. P-value of less than 0.5 was considered significant. <br><br><b>Results:</b> Conservative treatment was effective in all implemented cases, with no complications or rehospitalizations. Hospitalization duration correlated with age and presence of central nervous system (CNS) or thoracic injuries in multi-organ injuries, but not with sex or radiological American Association for the Surgery of Trauma (AAST) organ injury scales. Within abdominal organs, liver injury had the greatest impact on hospital stay length. Surgical intervention was required only in hemodynamically unstable patients or selected high-grade pancreatic injuries. Conservative management following APSA guidelines proved to be safe and effective, though concurrent injuries often prolonged hospitalization. Hospital stay length appeared to better reflect overall trauma severity than organ-specific injury grading. Imaging included eFAST (Extended Focused Assessment with Sonography in Trauma) and contrast-enhanced computed tomography (CEST); follow-up was typically conducted with standard ultrasound. No long-term complications were reported on. <br><br><b>Conclusions:</b> The application of APSA guidelines in diagnostic and therapeutic management in pediatric patients with blunt abdominal trauma is safe and effective. Nonoperative management remains the gold standard for stable pediatric abdominal trauma patients. <br><br><b>Significance for the field:</b> Conservative treatment of blunt abdominal injuries in children is a safe way of patient management and needs a raised awareness, especially among non-pediatric surgeons.